| Background and objection:Hematopoietic stem cell transplantation(HSCT)is an effective method for the treatment of diseases such as aplastic anemia(AA),leukemia,myelodysplastic syndrome(MDS),solid tumor and so on.With the use of high-dose radiotherapy and chemotherapy drugs and immunosuppression in the process of pretreatment,patients are in a state of severe neutrophil deficiency,inhibit cell growth and tissue repair,damage skin and mucosal barrier,resulting in a great decline in the ability of patients to resist infection.Patients are easily infected with a variety of pathogens such as bacteria,fungi,viruses and so on.Infection not only seriously affects the effect of transplantation,but also affects the long-term survival rate of patients after transplantation.At present,there are many studies on infection within 30 days after HSCT in China,but there are few clinical studies on infection in children at 180 days after HSCT.Therefore,the location of infection,the types of pathogens,the incidence of infection and the relationship between clinical risk factors and infection in the transplant center of our hospital were analyzed in order to provide reference for the prevention and treatment of complications after HSCT.Methods:Inpatients who underwent hematopoietic stem cell transplantation in the Second Affiliated Hospital of Dalian Medical University from April 2014 to August 2022 were selected as the subjects.The clinical data of 93 children after HSCT were retrospectively analyzed,including sex,age(<7.8 years old or≥7.8 years old),disease type,human leukocyte antigen(HLA)matching,pre-transplantation infection,the use of antithymocyte globulin(ATG),the occurrence of rejection,the compatibility of blood types between donors and recipients,transplant hospitalization time(<50 days or≥50days),duration of neutrophil deficiency(neutrophil deficiency duration)(<18 days or≥18 days),neutrophil implantation time(granulocyte implantation time)(≤11 days or > 11 days).The location of infection,the type of pathogen and the incidence of infection in different periods after HSCT were recorded.The correlation between clinical risk factors and infection was analyzed by statistical methods.Results:1.The incidence of infection in the early stage(0～30 days),the middle stage(30～100 days)and the late stage(100～180 days)after HSCT was 52.7%,61.3%and 25.8% respectively,and the incidence of first infection was 52.7%,29.0%and 8.6%,respectively.2.Bacterial infections mainly occurred in the early stage after HSCT,with an infection rate of 35.5%.The infection sites were mainly blood,urinary system and upper respiratory tract.Virus infection mainly occurred in the middle stage of HSCT,of which cytomegalovirus(CMV)was the most common,with an incidence of 19.4% of CMV infection,10.7% of EB virus(EBV)infection and9.7% of BK virus(BKV)infection.Fungal infection can occur in all periods after HSCT.The incidence of fungal infection in the early stage of HSCT,the middle stage of HSCT and the late stage of HSCT is 3.2%,4.3% and 5.4% respectively.3.Multivariate analysis showed that infection before transplantation,length of stay after transplantation,duration of neutropenia and time of neutrophil implantation were independent risk factors for bacterial infection after HSCT(P<0.05).4.CMV infection was the main type of virus infection.Multivariate analysis showed that rejection was an independent risk factor for virus infection after HSCT(P<0.05).Conclusion:1.Bacterial infection mainly occurred in the early stage after HSCT.With the extension of transplantation time,the incidence of bacterial infection after transplantation decreased.2.Viral infection mainly occurred in the middle stage after HSCT,among which CMV infection was the most common.Fungal infection occurred in all periods,but the incidence was low.The incidence of fungal infection increased with the extension of transplantation time.3.Bacterial infection after HSCT is related to infection before transplantation,long time of hospitalization,long duration of neutropenia and long time of neutrophil implantation.4.The risk of CMV infection in patients with rejection after HSCT was higher than that in patients without rejection. |
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